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Imaging:Thoracic TraumaTony TiemesmannDiagnostic RadiologyBloemfontein Hospital ComplexIntroductionVital StructuresHeart, Great Vessels, Esophagus, Tracheobronchial Tree, & Lungs25% of MVC deaths are due to thoracic trauma12,000 annually in USAbdominal injuries are common with chest trauma.Prevention FocusGun Control LegislationImproved motor vehicle restraint systemsPassive Restraint SystemsAirbags

Anatomy 1Thoracic Skeleton12 Pair of C-shaped ribsRibs 1-7: Join at sternum with cartilage end-pointsRibs 8-10: Join sternum with combined cartilage at 7th ribRibs 11-12: No anterior attachmentSternumManubriumJoins to clavicle and 1st ribJugular NotchBodySternal angle (Angle of Louis)Junction of the manubrium with the sternal bodyAttachment of 2nd ribXiphoid processDistal portion of sternum

Anatomy 2

43 weeks of gestation in humansNeuralcrest

Anatomy 35Step 1: Neural groove forms.Anatomy 4MediastinumCentral space within thoracic cavityBoundariesLateral: Mediastinal pleuraInferior: DiaphragmSuperior: Thoracic inletPosterior: Thoracic spineAnterior: Sternum & costal cartilagesSuperior & Inferior mediastinumInferior mediastinumAnteriorMiddlePosterior

Anatomy 5Structures (superior)Great VesselsOesophagusTracheaNervesVagusPhrenicThoracic DuctStructures (inferior)Anterior fat, lymph nodesMiddle heart, aorta, lower SVC, Trachea & main bronchi, lymph nodes, pulmonary veins & arteries, phrenic nervePosterior Aorta, oesophagus, azygous & hemiazygous, thoracic duct, vagus6 weeks4 weeksHeartHeartGeneral StructurePericardiumSurrounds heartVisceralParietalSerous35-50 ml fluidEpicardiumOuter LayerMyocardiumMuscular layerEndocardiumInnermost layer

Great VesselsGreat VesselsAortaFixed at three sitesAnnulusAttaches to heartLigamentum ArteriosumNear bifurcation of pulmonary arteryAortic hiatusPasses through diaphragmSuperior Vena CavaInferior Vena CavaPulmonary ArteriesPulmonary Veins

OesophagusEsophagusEnters at thoracic inletPosterior to tracheaExits at esophageal hiatus

PathophysiologyBlunt & Penetrating TraumaResults from kinetic energy forcesSubdivision MechanismsBlastPressure wave causes tissue disruptionTear blood vessels & disrupt alveolar tissueDisruption of tracheobronchial treeTraumatic diaphragm ruptureCrush (Compression)Body is compressed between an object and a hard surfaceDirect injury of chest wall and internal structuresDecelerationBody in motion strikes a fixed objectBlunt trauma to chest wallInternal structures continue in motionAge FactorsPediatric Thorax: More cartilage = Absorbs forcesGeriatric Thorax: Calcification & osteoporosis = More fractures

Cardiovascular 1Myocardial ContusionOccurs in 76% of patients with severe blunt chest traumaRight Atrium and Ventricle is commonly injuredInjury may reduce strength of cardiac contractionsReduced cardiac outputElectrical Disturbances due to irritability of damaged myocardial cells

Cardiovascular 2Pericardial TamponadeRestriction to cardiac filling caused by blood or other fluid within the pericardiumOccurs in